All Forms
Black Hills Pediatrics, LLP
- ADHD – Parent Form
- ADHD – Teacher Form
- Authorization For Use and Disclosure of PHI To Personal Representatives – Patient under 18 Years of Age
- Authorization For Use and Disclosure of PHI To Personal Representatives – Patient 18 Years of Age or older
- Employment Application
- Failure to Keep Appointment Policy
- Medical Consent Form for Treatment
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- Personal Relationship Consideration Policy
- Medical Records Release FROM our Clinic
- Medical Records Release TO our Clinic
- Notice of Privacy Practices (NPP)
- Patient Medical History
- Patient Registration​
- Privacy Practices Acknowledgment & Patient Consent for Use and Disclosure of Protected Health Information
- Sports Physical History Form
- Vaccine Consent Form
Convenient Digital Patient Forms
At Black Hills Pediatrics, LLP, our goal is to provide your child with the best health care possible. We also strive to make your experience as their parent as enjoyable as possible.
To streamline the medical treatment process, we've created digital versions of our patient care and consent forms. If your child's pediatrician requests that you complete any of the following forms prior to treatment, please do so by clicking on the applicable link below.
If you have any questions about completing any of the following forms, please don't hesitate to call our office at (605) 341-7337 to speak with one of our staff members.
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